甲状腺疾病(英文版)课件

ThyroidDisorders1.ThyroidDisorders1.WordListThyroiddisorders甲状腺病症Isthmus峡部Thyroxine甲状腺素Triiodothyronine三碘甲状腺氨酸Parathyroidglands甲状旁腺Calcitonin降钙素2.WordListThyroiddisorRecurrentlaryngealnerve喉返神经Hyperthyroidism甲亢Hypothyroidism甲减Goitre甲状腺肿Exophthalmos突眼症Tremor震颤TSH促甲状腺激素3.RecurrentlaryngealnerveThyroidectomy甲状腺切除术Thyroidcrisis甲状腺危象Atracheostomyset气管切开包Tetamy手足抽搐4.ThyroidectomyThyroidGlandItisapartoftheendocrine(内分泌)system,playsamajorroleinregulatingthebody'smetabolism.5.ThyroidGlandItisapartoftSection1Anatomy/physiologyofthyroid6.Section1Anatomy/physiologyofPlaceBloodsupplyNervessupplyFunctionsAnatomy/physiologyofthyroid7.PlaceAnatomy/physiologyofthyLocatedinthelowerneckanteriortothetrachea.Twolaterallobesconnectedbyanisthmus（峡部）Butterfly-shapedorgan5cmlong,3cmwide，30gTheparathyroidglands（甲状旁腺）

lyingonthedorsalside（背面）

ofthethyroidgland.8.LocatedinthelowerneckanteRich,fromthesuperiorandinferiorthyroidartery.Artery:Thearterialbranchesprovidebloodsupplytootherstructuresinthearea.Theinteriorthyroidarteryprovidesbranchestothepharynx,tracheaandesophagus.Vein:1)Thesuperiorthyroidvein2)Themiddlethyroidvein3)Theinferiorthyroidvein9.Rich,fromthesuperiorandiThenervessupplyingthethyroidoriginatefromvagus(迷走神经）,innervatetheepithelialcells（上皮细胞）

ofthefollicles（滤泡）

ofthethyroidgland.Onemustbeawareofthebilateralexistenceofarecurrentlaryngealnerve（喉返神经）

duringdissection.10.ThenervessupplyingthethyroProduces,synthesizes,stores,andsecretesTwoHormonesCalledThyroxine(T4)Thyronine(T3)RegulatesMetabolismsoYourCellsFunctionProperlyAffectsEveryCellintheBody,necessaryfornormalgrowthanddevelopment11.Produces,synthesizes,storesCommondisorder:AdeficiencyofiodineOtherdisorder:AutoimmunethyroiddiseaseClassification:Hyperthyroidism(甲亢）,hypothyroidism（甲减）,tumours,cancerorgoitre（甲状腺肿）.12.Commondisorder:AdeficiencyWhentheThyroidDoesn’tWorkHyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUpHypothyroidismTooLittleThyroidHormoneMetabolismSlowsDown13.WhentheThyroidDoesn’tWorkHHyperthyroidism

(甲状腺功能亢进）14.Hyperthyroidism

(甲状腺功能亢进）14.DefinitionHyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone.15.DefinitionHyperthyroidismiCause:Increasedsecretionofthyroidhormone.Females:males=4:1,ittendstoaffectmalesmoreseverely.Incidence:20~40yearsoldgroup.16.Cause:IncreasedsecretionofClinicalManifestationGoiterExophthalmos(突眼征）IncreasedmetabolicrateIncreasedfunctionofsympatheticnerve

(交感神经）Cardiovascularalteration17.ClinicalManifestationGoiter1

Thethyroidcanbepalpatedforasymmetry(不对称）

andsize.Itmayenlarge3-4timestoitsnormalsize.Itiscalledgoitre.18.ThethyroidcanbepalpatedHyperthyroidism

19.Hyperthyroidism

19.20.20.Asaresultofincreasedthyroidhormoneproduction,theclienthasanincreasedmetabolicrate.Weightlossdespiteincreasedappetite,fatigue,poortolerancetoheat,andprofuseperspiration,menstrualirregularities.21.AsaresultofincreasedthyroNervous,restlessness,irritability,difficultyconcentrating,emotionalliability,moodswings,personalitychanges.Finetremorsofthefingersandtongue,shakyhandwriting,clumsiness,troubleinclimbingstairs,ordyspneapossiblyatrest.22.Nervous,restlessness,irritabTheskiniswarmandmoist,characteristicsalmoncolour(鲜肉色）.Thehairisfineandsoftwithprematuregreyandincreasedhairloss.Thenailsappearfragilewithdistalnailseparationfromthenailbed.23.Theskiniswarmandmoist,c

Tachycardia:

＞160bpmanddownto80bpmduringsleep.

Pulsepressureiswidened.Therecanbemuscularweaknessandatrophy(萎缩）,paralysis（瘫痪）.24.Tachycardia:＞160bpmanddDiagnosticTestsTSH（促甲状腺激素）T3,T4Radioactiveiodineuptake（Ⅰ131）ThyroidscanMensurationofbasicmetabolismrate(BMR)25.DiagnosticTestsTSH（促甲状腺激素）25.TSH(Thyroid–StimulatingHormone)normalTSHreflectaeuthyroid(甲状腺机能正常的）

state.Hyperthyroidism:TSHisloworabsent.Inmildformsofhyperthyroidism:slightlyabnormal.26.TSH(Thyroid–StimulatingHormoThyroidscanScanarehelpfulindetermininglocation,size,shape,andanatomicfunctionofthethyroidgland.27.Thyroidscan27.Mensurationof

BasicMetabolismRate(BMR)

Conditions:Earlyinthemorning,emptystomach,atthetimeofrestBasicMetabolismRate

=(Pulserate+Pulsepressure)-11128.Mensurationof

BasicMetabolGradeNormal:±10%Slightlyabnormal:+20%~+30%Moderatelyabnormal:+30%~+60%Seriouslyabnormal:＞+60%29.GradeNormal:±10%29.TreatmentAntithyroiddrugs,radioactiveiodine,orthyroidectomy(甲状腺切除术）.Individualizedanddependsontheageandgeneralstateofhealth，thesizeofthegoiterandtheabilitytoobtainfollow-upcare.30.TreatmentAntithyroiddrugs,rPartialorcompletethyroidectomymaybecarriedoutasprimarytreatment.Thetypeandextentofthesurgerydependonthediagnosis,goalofsurgery,andprognosis.31.PartialorcompletethyroidectSurgicalIndicationsAverylargegoiteroramultinodulargoiterwithrelativelylowradioactiveiodineuptakeMalignantthyroidnodulePsychologicallyormentallyincompetentpatients32.SurgicalIndicationsAverylarSurgeryAportionofthethyroidglandisremoved,butatotalthyroidectomymaybeperformed(expensive,risks).Indicationsforsubtotalthyroidectomy:themainadvantagesarerapidcontrolofthediseaseandalowerincidenceofhypothyroidismthancanbeachievedwithradioiodinetreatment.33.SurgeryAportionofthethyroiSurgeryIfapartialthyroidectomyisdone,theremainingthyroidtissueshouldprovideadequateamountsofthyroidhormones.Ifacompletethyroidectomyisdone,theclientwillrequirethyroidhormonereplacementforalifetime.

34.SurgeryIfapartialthyroidectTheneckisextendedandasymmetrical,gentlycurvedincisionismade1to2cmabovetheclavicle（锁骨）.Closureofthewoundisaccomplishedbythestrapmusclesinthemidline.Asmallsuctioncatheterisusuallyinsertedthroughastabwound.35.TheneckisextendedandasymComplicationsaftersurgery

Dyspnea,asphyxiaInjuryoflaryngealnerveSpasmsThyroidcrisis（甲状腺危象）36.Complicationsaftersurgery

DyHaemorrhageHaematoma(血肿）formationTrachealcollapse（气管塌陷）TrachealmucousaccumulationLaryngealorlocaltissueedema

Cause37.HaemorrhageCause37.Complicationsaftersurgery

Respiratorydistressandhaemorrhage.Difficultyinrespiration

whichistheoccurswithinafterthesurgery.mostcriticalcomplication48hours38.Complicationsaftersurgery

RManagementSurgicalevacuationisrequired.

ThefirstaidbythebedA.cutoffthesutureB.openedthewoundwideC.removedthehematomaThetracheaiscut,applyoxygenSendtotheoperationroomforfurthertreatment.

39.ManagementSurgicalevacuationPreventiveinterventions

Atracheostomyset(气管切开包）iskeptatthepatient’sbedsideatalltimes,andthesurgeonissummonedatthefirstindicationofrespiratorydistress.

40.Preventiveinterventions

AtraInjuryoflaryngealnerveAnyvoicechangesarenotedbecausetheymightindicateinjurytotherecurrentlaryngealnerve（喉返神经）,whichliesjustbehindthethyroidnexttothetrachea.

Talkaslittleaspossible.Canbecuredspontaneously,orbyphysicaltherapy.41.InjuryoflaryngealnerveAnyvSpasmTheparathyroidglandsmaybeinjuredorremoveddisturbanceofthecalciummetabolismofthebodybloodcalciumlevelfallsspasmsofthehandsandfeetandmusculartwitching“tetany”laryngospasm42.SpasmTheparathyroidglandsManagementTemporaryLimittakingofmeat,eggswhicharehighinphosphorus（磷）UseofthesedativetocontrolthepainIntravenousadministrationofcalciumgluconate葡萄糖酸钙

43.ManagementTemporary43.Thyroidcrisis(storm)Reason:insufficientpreoperativepreparation,areleaseoflargeamountsofthyroidhormone,rareOutcome:canleadtocardiac,hepaticorrenalfailure.Stressfulfactors:surgery,infectionortrauma,pregnancy.

44.Thyroidcrisis(storm)Reason:Timeofoccurring:thefirst12hourspostoperative.Clinicalmanifestation:

Tachycardia(＞130bmp)T＞39℃,sometimes＞41℃ExaggeratedsymptomsofhyperthyroidismDisturbancesofamajorsystem

45.Timeofoccurring:thefirst

Gastrointestinal

(diarrhea,abdominalpain)

Neurologic(psychosis,somnolence,coma)Cardiovascular

(edema,chestpain,dyspnea,palpitations)

46.Gastrointestinal46.Fatalness:Theclientmaydevelopcongestiveheartfailureanddie.Preventions:Thekeyistodothepreoperativepreparationsufficiently,andperformthesurgeryuntiltheBMRbecomenormal.47.Fatalness:TheclientmaydeveMedicalManagementThephysicianmustbeinformedimmediately.TransferthepatienttotheintensivecareforclosermonitoringIodineisadministeredtodecreasetheoutputofthyroidhormone.TakeKIsolution3mlorally,orput10%iodinesodium5mlintoin10%glucose,andgiveivinjectiontothepatient.

48.MedicalManagementThephysicia200~400mgHydrocortisone氢化可的松

isprescribedtotreatshockoradrenalinsufficiency.Theusageofsedative(luminal鲁米纳Q6-8h)Reducebodytemperatureandheartrateandtopreventvascularcollapse(37℃).

Alargeamountofglucoseareneeded.49.200~400mgHydrocortisone氢化可的松Oxygentherapy:

Humidifiedoxygenisadministeredtoimprovetissueoxygenationandmeetthehighmetabolicdemands

Cardiacproblems:arterialfibrillation,andcongestiveheartfailure,sympatholyticagentsmaybeadministered,suchaspropranolol(心得安)50.Oxygentherapy:HumidifiedoxPreoperativecarePerfectpreoperativecareBaselineinformationPharmacologictherapyMentalsupportNutritionInstruction51.PreoperativecarePerfectpreopPharmacologictherapy

Itisnecessaryforsurgicaltreatment,butitcannotactasatherapueticmedication.Encouragesthepatienttotakethemedicationsasprescribed.Iodinepreparationsmayhavebeenprescribed10to14daysbeforesurgerytodecreasethyroidvascularityanddecreasebleeding.52.Pharmacologictherapy

Itisne

2to5dropsofpotassiumiodidesolution(复方碘化钾)orLugol’siodinesolution

(卢戈氏液)aregiveninconjunctionwithpropylthiouracil

(丙基硫尿嘧啶)todecreasethefriabilityandvascularityofthethyroid,itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid..53.2to5dropsofpotassiumiodRequirement:euthyroidPatient'smoodissteady,thesleeptakesafavorableturn,gainweight,pulserate<90times/min,BasicMetabolismRate<+20%.情绪稳定、睡眠正常、体重增加、心跳正常、代谢恢复54.Requirement:euthyroid54.NutritionSeveralwell-balancedmealsofsmallamount,evenuptosixmealsaday.Highlyseasonedfoodsandstimulants,suchascoffee,tea,cola,andalcoholarediscouraged.High-calorie,high-proteinfoodsareencouraged.

55.NutritionSeveralwell-balancedPreoperativeteachingHowtosupporttheneckwiththehandsaftersurgerytopreventstressontheincision.Eyecareandprotectionmaybecomenecessary,correctinstillationofeyedropsorointmentprescribedtosoothetheeyesandprotecttheexposedcornea.

56.PreoperativeteachingHowtosuPostoperativecarePositionObservationOxygenNutritionMedicationHealthinstruction57.PostoperativecarePositi